| NPI | 1740655216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 002754) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI 2033) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2023-09-11 |